Division of Developmental Disabilities
Positive Behavior Support
January 2013
Positive Behavior Support 2
Copyright © 2018 Arizona Department of Economic Security. Content may be used for educational purposes without written permission but with a citation to
this source.
Learning Outcomes:
1. Participants will define and describe the term behavior. 2. Participants will list three reasons/causes/functions of target behavior. 3. Participants will describe and give examples of at least three components of the
behavior cycle. 4. Participants will list and give examples of at least three behavioral change strategies. 5. Participants will list at least two examples of teaching strategies and alternative
behaviors. 6. Participants will define the term reinforcer and will list three rules for effective
reinforcers.
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Positive Behavior Support 4
Our Role in Behavior Support
People (including caregivers) do not control others, but support others in their own behavior change process.
People don’t resist change.
People resist being changed.
Our Role in Behavior Support Apply knowledge about understanding people and make humane changes in their lives that can reduce the occurrence of challenging behavior. This includes facilitating improvement of life quality by improving life circumstances and teaching the person effective and positive ways to adapt and respond to their environment.
Positive Behavior Support is based on four things:
1. An understanding that people (even caregivers) do not control others, but seek to support other in their own behavior change process.
2. A belief that there is a reason behind most difficult behavior, that people
with difficult behavior should be treated with compassion and respect, and that they are entitled to lives of quality as well as effective services.
3. The application of a large and growing body of knowledge about how to
better understand people and make humane changes in their lives that can reduce the occurrence of difficult behavior
4. A conviction to continually move away from the threat and/or use of
unpleasant events to manage behavior.
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Myths About Difficult Behaviors
Myth #1 – Only people with Developmental Disabilities have problem behaviors. Who has problem behaviors? _______________________________________ Myth #2 - People with Developmental Disabilities have problem behaviors as a result of their Disability.
Notes on David Pitonyak’s Video _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
_________________________________________________________
_________________________________________________________ _________________________________________________________ _________________________________________________________
Having a Quality Life
What contributes to having a good quality of life?
• _____________________________________________________________ • _____________________________________________________________ • _____________________________________________________________ • _____________________________________________________________ • _____________________________________________________________ • _____________________________________________________________ • _____________________________________________________________ • _____________________________________________________________
How does it benefit the people that we support to have a quality life?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Quality of Life Impact
Happiness
A
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Self:______________________________________________________________ Intimates:__________________________________________________________ Friends:___________________________________________________________ Acquaintances participation:___________________________________________ Acquaintances exchange:______________________________________________
Self
Intimates
Friends
Acquaintances participation
Acquaintances exchange
Relationships
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Defining and Describing Behavior
Behavior is anything that a person ____________________ that can be
______________________ and ____________________.
Behavior is action.
If you want to change behavior, including teaching behavior, you must clearly describe the behavior.
Answering the following questions can help you to describe the particular behavior.
• What is a label for the behavior? • What are the circumstances when the behavior occurs? • How often will/does the behavior occur? • What happens before the behavior? • What happens after the behavior? • What motions and body parts are involved? • How big, small, energetic, fast are the motions? • What sounds are part of the behavior (if any)? • Is there a product or result? What does that look like? • How long does the behavior last? • Are there any objects or other people involved or affected?
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Defining and Describing Behavior Name three ways that behavior is beneficial:
• ________________________________________________________________
• ________________________________________________________________ • ________________________________________________________________
All Behavior Is Meaningful
• To get something that is desired, wanted, needed • To escape from or avoid something • To provide sensory input, sensory organization or avoid sensory input • To express emotion, hunger, pain, thirst, distress • To reduce anxiety or stress; • For entertainment; • Due to biological factors (seizures, medication) • To tell us (communicate) something, engage us
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Behavior
An Action What somebody does Can be seen/observed Can be measured/counted Has a beginning & an end/Start and Stop Serves a purpose, is functional, meaningful Communicates something
Describing and Evaluating Behavior
– Determining the Importance and Impact of the Behavior – Describing the Behavior – Analyzing the Functions of the Behavior
How do we determine that a behavior is having a negative impact on a person’s quality of life?
• ___________________________________________________________
• ___________________________________________________________
• ___________________________________________________________
What is the reason that the behavior need to be described?
• ___________________________________________________________
• ___________________________________________________________
• ___________________________________________________________
Hello! Are you listening?
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Target Behavior
Target Behavior: The behavior that is having a negative impact on a person’s life. This is a behavior that is identified as needing to decrease. Alternative Behavior: For every identified target behavior, we will also have an alternative behavior, which is a positive behavior that we are working to increase. More on alternative behaviors to come!
How is measuring behavior important?
• We take data so that we can objectively record a ________________in behavior.
• Data gives us more _______________ about behavior so that we can better understand.
• Baseline data is data that we take before we teach or change things with, for or around a person.
Baseline Data
Examples of Target Behaviors include:
• _____________________________________________________________
• _____________________________________________________________
• _____________________________________________________________
• _____________________________________________________________
• _____________________________________________________________
• _____________________________________________________________
• _____________________________________________________________
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Message in a Bottle
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ What Are Some Causes/Reasons/Functions of Target Behaviors?
• ______________________________________________________
• ______________________________________________________
• ______________________________________________________
• ______________________________________________________
• ______________________________________________________
• ______________________________________________________
• ______________________________________________________
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Calvin and Hobbes by Bill Watterson
Bill Watterson and Universal Press Syndicate hold the copyright for the image members.shaw.ca/dlazechk02/subjects.html
List some possible functions for this behavior:
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
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The Analysis of Behavior
• Definition • Setting Conditions and Antecedents • Consequences • What Are the Causes/Reasons/Functions? • What Are the Rewards? • What Has to Be Learned and Who Has to Learn It?
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Behavior Cycle
During
After
Before • Someone walks in the room. • I smile.
• Person smiles at me. • High five in return.
• I give a high five.
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Before: Setting Events Those situations that generally raise stress and anxiety. Those circumstances that diminish coping and ability to adapt. Not a single situation or particular circumstance, but ongoing.
Examples of Setting Events:
• ____________________________________________________
• ____________________________________________________
• ____________________________________________________
• ____________________________________________________
• ____________________________________________________
• ____________________________________________________
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Before: Antecedent (“Trigger”)
Single, discrete events that occur before a behavior. A trigger and sometimes root of the behavior. They happen to someone. They are subject to manipulation . They can be external or internal.
Examples of External Antecedents:
• ________________________________________________________
• ________________________________________________________
• ________________________________________________________
• ________________________________________________________
Examples of Internal Antecedent Events:
• _________________________________________________________
• _________________________________________________________
• _________________________________________________________
• _________________________________________________________
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Before: Precursors “Mini-Behaviors” or “Cues”
(first links in the chain)
• Behaviors displayed by the person before the “target” behavior occurs • Signals/Warning signs that the “target” behavior is coming • In some cases, may be developed into the alternative appropriate behavior • Do not always appear “related” to the target behavior • May rapidly escalate
Examples of Precursors:
• _________________________________________________________
• _________________________________________________________
• _________________________________________________________
• _________________________________________________________
• _________________________________________________________
• _________________________________________________________
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During
This is NOT a teaching moment.
• Remain calm • Be aware of your communication (verbal and nonverbal) • Keep a safe distance • Be aware of your environment • Demonstrate respect • Validate a person • Pay attention to what the person is communicating, including body
language, and adjust behavior accordingly
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After: Consequences “Payoff”
Consequences are the direct ______________or _______________ of the
behavior. Consequences can occur in a person’s _______________, in the
_______________ and can be the __________________of others to the behavior.
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Before
Sometimes, you’ll hear “setting events” or “antecedents” when talking about the Before stage. These are things that make a behavior – positive or challenging – more likely to happen. People show signs, or “precursors,” that something is about to happen. Signs may include rocking, biting nails, mumbling, etc
At each stage, we need to ask:
What did we learn? What can be done differently in the future?
During The During stage includes the actions the person takes. The actions are observable, measurable: actions we can see and/or hear. There is a starting and ending point.
After After the behavior is the consequence stage. This includes anything that happens after the behavior.
This is a time for teaching and setting a person up for future success. For challenging behaviors, it may be a time to help a person rebuild relationships.
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I Am Sam Video Activity
__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
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Target Behavior Definition – I Am Sam (During)
• What is the “Target Behavior”? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ • What is the Beginning/”On-Set” of the behavior?
________________________________________________________________ ________________________________________________________________ ________________________________________________________________
• What is the End/”Off-Set” of the behavior? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
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Before: I Am Sam
What were the possible circumstances (setting events) and triggers (antecedents) that made the behavior more likely to occur?
_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ What physical signs (precursors) did you see that indicated that the Target Behavior was about to happen?
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
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After: I Am Sam
What happened after the behavior (consequences)?
Consider: • What were the things added to the situation after the behavior that may
have rewarded the behavior? • What were the things avoided, taken away or delayed that may have
rewarded the behavior? • What were the things that happened after the behavior that probably did
not reward the behavior?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
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________________________________________________________________
________________________________________________________________
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The Next Step – Assessment
What’s the Reason We Do Assessment? To better understand the reason, where, when, how, so we can:
• Better address problems • Make needed changes
• Better support the person • Teach what is needed and will work • Know best ways to teach • Identify additional supports needed • Develop a better plan
What We Assess – What Information Are We Trying to Gather?
– All Parts of the Behavior Cycle
• ___________________________________________________ • ___________________________________________________
• ___________________________________________________
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Assessment
“It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.” – Sherlock Holmes, A Scandal in Bohemia
“It is a capital mistake to theorize before you have all of the evidence. It biases the judgment.” – Sherlock Holmes, A Study in Scarlet
What do the Sherlock Holmes quotes have to do with the analysis of behavior? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
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Supplemental Information
Cliff is 12 years old. He loves video games, dancing, and has a diagnosis of autism. He does not communicate using words, but does use some limited sign language. He has about 20 signs he uses regularly. His parents called you today saying they don’t know what to do. They said Cliff has started taking his clothes off “all the time” and he was recently kicked out of the arcade. His parents said they have tried everything and are out of ideas. Use the supplemental information packet to determine what forms may help the conversation with Cliff and his family. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
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Change Strategies:
With your table, identify 1 strategy per page that is new to you or that you really like.
Health Needs and Issues
_____________________________________________________________
Environmental Manipulation
_____________________________________________________________ Routine
_____________________________________________________________ Behavior of Support Givers
_____________________________________________________________ Therapy Needs and Issues
_____________________________________________________________
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Ecological Strategies: Health Needs and Issues
Are there any health issues that could contribute to the occurrence of the challenging behavior?
Diet? Dental? Gastro-intestinal? Lungs and breathing? Circulatory? Urinary? Skin? Skeletal? Neurological? Musculature? Endocrine? Hormonal? Seizures? Medication – Side effects? Vision? Hearing? Pain? Allergies? Sleeping patterns? Behavioral health?
How are health needs and issues affecting the occurrence of challenging behavior being addressed?
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Ecological Strategies: Environmental Manipulation
Questions to Ask:
– What are the things we need to change in the environment (where the person lives, spends the day, etc.) to better meet the person’s needs?
– What are the things we need to change to eliminate barriers? – What are the things we need to change to increase coping? Decrease
stress? – What are the things we need to add to support success?
Some considerations to change in the environment to decrease the chance of a target behavior:
• Temperature • Lighting • Colors • Sound • Textures • Smells • Arrangement • Crowding • Organization • Stimuli • Personal Products • Equipment • Furniture • Walls • Window Coverings • Clothing • Bedding • Surfaces
• Floors • Traffic Flow • Adaptations • Availability • Access • Inside • Outside • Animals • Allergens • Ventilation • Humidity • Cleaning Products • Security • Privacy • Plants
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Ecological Strategies: Routines
Calvin and Hobbes by Bill Watterson
Bill Watterson and Universal Press Syndicate hold the copyright for the image members.shaw.ca/dlazechk02/subjects.html
o Is there a schedule? o What is the schedule for the individual and others in the environment? o Does it work for everyone? o Does the person have adequate support in the schedule? o Does the schedule meet the needs of the person? o Does it include activities that are meaningful and relevant? o Are there opportunities for learning in the routine? o Is teaching occurring during the routine? o What is the pacing of the schedule? o Are transitions adequate? o How are changes made? o Who develops the schedule? o Is the person involved in planning? o What are the choices during the routine? o Are choices offered regularly during the routine? o How does the person know what the schedule is? o Is the schedule communicated in a way that the person can understand? o Is the schedule posted or readily available to consult? o Are day to day changes in the routine communicated to the person? o How are the changes communicated? o Are the changes communicated in a way the person understands? o What changes are necessary in the routine to assure that the person is adequately supported,
involved, understanding, learning and making choices in the routine?
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Ecological Strategies:
Behavior of Support Givers Calvin and Hobbes by Bill Watterson
Bill Watterson and Universal Press Syndicate hold the copyright on the image members.shaw.ca/dlazechk02/subjects.html Some questions to consider:
o How long have support givers known the person? o Do they know the history, talents, strengths, likes, dislikes, patterns and needs of the person? o Do they know how the person learns best? o Do they know what to avoid? o Can they identify the setting conditions and antecedents to challenging behavior? o Do support givers use effective teaching skills? o Do support givers avoid the use of the word “No”? o Do support givers offer effective choices? o Do support givers follow health, safety and therapy recommendations? o Do support givers provide structure? o Do support givers allow adequate time for processing, transition and learning? o Do support givers focus on what they want the person to do and not what they should not do? o Do support givers acknowledge and reward positive, effective behavior displayed by the
person? o Are there any physical attributes of support givers that are more effective for the person? o Are there any personality or behavior attributes of support givers that are more effective with
the person? o Are there any specialized skills that support givers should have to better support the person?
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Ecological Strategies: Therapy Needs and Issues
Are there therapy needs and issues contributing to the occurrence of challenging behavior?
• Communication – Speech and Language • Occupational Therapy – Use of fine motor skills in doing daily activities • Physical Therapy – Use of major motor skills in movement and posture • Sensory Integration Therapy – Processing, integrating and understanding
input from the sensory systems including kinesthetic, vestibular, proprio-receptive, tactile, visual, auditory, oral-motor
How are therapy needs and issues affecting the occurrence of challenging behavior being addressed? Do we need more information/evaluation regarding these issues? How are we getting the information necessary?
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What Has to Be Learned & Who Has to Learn It?
• The Person
– New Skills
– Developing/Refining Skills
– New Patterns
– New Expectations
• Support Givers
– To Better Support the Person
– To Teach Skills
– New Patterns
– New Expectations
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Alternative Behaviors
Alternative Behavior: The new behavior we are working to increase.
Greater Effectiveness and Efficiency
• Any alternative behavior that is taught and established must be at least as effective and efficient in meeting the needs of the person as the target inappropriate behavior that it is intended to replace.
• The environment must respond at least as well to the replacement
behavior as the “problem” behavior.
• It is preferable that the alternative behavior works better than the challenging behavior.
Remember: Our Role is not to control others, but to support people in their own behavior change process. We can not take away a form of communication without at least one effective replacement.
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Alternative Behaviors
Functionally Equivalent – Appropriate behavior(s) that serve the exact same function(s) as the
target inappropriate behavior and are topographically similar. – In other words positive, effective behavior that serve the same
purpose(s) as the “problem” behavior and that look, feel and move like the problem behavior.
Functionally Related
• Behavior(s) that serve a purpose that is related to the function of the target inappropriate behavior, but is/are not an exact replacement for the target inappropriate behavior.
Coping Skills
• Behavior that does not serve the purpose of the target inappropriate behavior, but allows the person to cope with the circumstances and triggers that bring about the target behavior.
• This includes:
– Relaxation skills – Desensitization – Voluntary time out
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Incompatible Behavior
• Behavior that while occurring does not allow for the occurrence of the target inappropriate behavior.
• Both behaviors cannot occur at the same time.
General Skill Development
• Increasing the scope and numbers of appropriate, positive behaviors that the person does and can use to meet his/her needs and live life effectively.
• Providing the person with greater numbers and variety of skills, and the opportunity and expectation to use them decreases the time during which the person can display inappropriate behavior.
• This increases the person’s ability to address their own needs in effective and acceptable ways.
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Teaching Techniques Refer to Article 9 for more ideas
Task Analysis • Breaking a behavior or task into a series of steps in order to teach
and do the task. • Size and number of steps are considered for the individual learner.
__________________________________________________________________ __________________________________________________________________ Chaining
• A method of teaching behavior as a series of inter-linked steps so that the steps of the behavior itself act to signal or prompt the next step.
• Trainer assistance is faded from the steps of the task that the learner masters first.
• Assistance can be faded from the first steps (forward chaining), last steps (backward chaining) or middle steps (global chaining) of the task.
__________________________________________________________________ __________________________________________________________________ Additional Ideas __________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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The Magic of Reinforcement
What is a reinforcer?
Any __________________occurring or presented after a behavior that will increase the strength of the behavior. The frequency (# of times it happens), duration (how long it happens) or intensity (with how much energy it happens) of a behavior
1) If the item or event does not increase or maintain the
behavior, it is NOT a reinforcer. 2) For the item/event to increase/maintain behavior, it must be perceived as
good by the person 3) Reinforcers are not bribes. They are one type of natural or planned
consequences that result from our behavior. 4) None of us do any action because “we are supposed to.”
5) The challenge is understanding what is truly motivating our actions.
Reinforcement is a continuous and life long process in which we all participate.
Types of Reinforcers Positive (+): When something is ______________ to the situation that the person likes or wants.
Negative (-): When a negative condition is _____________ following the behavior and therefore, the situation improves.
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Article 9 and Teaching New Behaviors
What limits does Article 9 place on teaching strategies, reinforcers, and consequences?
Prohibitions: NEVER, NEVER, NEVER!!!
1. _____________________________________________________________ 2. _____________________________________________________________ 3. _____________________________________________________________ 4. _____________________________________________________________ 5. Behavior modifying medications if:
a. ______________________________________________________ b. ______________________________________________________ c. In a licensed residential setting without a behavior plan
6. A.R.S. 36-561.A: Psycho-surgery, insulin shock, experimental procedures,
etc. What techniques require a behavior plan, and review and approval prior to being implemented?
• _____________________________________________________________
• _____________________________________________________________
• _____________________________________________________________
• _____________________________________________________________
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The Magic of Reinforcement
Each person is unique and what motivates each person is unique to him/her. There are three basic ways to determine rewards that work for an individual.
Watch:
Ask:
Try:
Rules for Effective Reinforcement • _____________________________________________________
• _____________________________________________________
• _____________________________________________________
• ______________________________________________________
• ______________________________________________________
• ______________________________________________________
• ______________________________________________________
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Types of Reinforcers For all the reinforcers, remember a person’s dignity and Article 9.
Social Reinforcers
_________________________________________________________________ _________________________________________________________________
Material Reinforcers
_________________________________________________________________ _________________________________________________________________
Token Economies
________________________________________________________________ ________________________________________________________________ *Article 9 Reminder: Once a token has been earned, a provider may not take away that token without an approved behavior plan.
Special Activities and Privileges:
_________________________________________________________________ _________________________________________________________________
Intrinsic
This is a reinforcer that cannot be planned by the team. Intrinsic reinforcers are “self-rewards” – doing something because it makes the person feel good.
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The Ethical Use of Reinforcers Reinforcers require control. The person cannot have ready access to the reinforcer. Due to this, certain guidelines (including Article 9) must be used in considering what can and cannot be used as a reinforcer.
• Items or activities that are addictive can not be reinforcers, such as coffee or cigarettes.
• Items or activities that a person relies upon for coping and comfort in stressful situations can not be used as a reinforcer.
• Avoid using items or activities that belong to the person. • Avoid using items or activities that most people would have freely
available to them.
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Types of Consequences Natural: Determined by physics and nature; no one else applies them. Natural consequences happen every time. Logical: Consequence that is logically linked to the behavior; may be applied or required by others. Logical consequences are often restorative in nature. Non Award of Reinforcement: Rewards that may have been given for non-occurrence of the behavior and/or for the display of appropriate replacement behavior are not provided. Decompress/Stress Release: A natural consequence that may be that the person experiences a release of stress. The person may be encouraged to do a stress-releasing activity. Other may remove further stressors from the environment. Teaching: The alternative behavior may be taught, and the person may be encouraged to think about what has happened and analyze the situation and identify alternatives. Restorative and reconciliatory activities may be taught.
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After Immediate Consequences
1. Reconnection Once a person has displayed a challenging behavior, there is a need for reconnection to others in the environment, to the routine and schedule, and with any ongoing activities.
2. Reconciliation Reconciliation includes rebuilding relationships, repairing relationships, and restoring a person’s self-esteem and value
3. Restoration The environment and routine need to be restored following a challenging behavior
4. Learning We need to always look at what we learned from the situation, and what can be taught to the person or others supporting the person.
5. Further Analysis We need to evaluate the situation to see how we can improved in the future
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10 Ways to Support a Person with Difficult Behaviors David Pitonyak
Individually, read your assigned section of the article. Based on what you read, summarize your section in 1-2 sentences:
_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
What is one way in your job you can do this?
_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
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Equal Opportunity Employer/Program Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, and disability. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact the Division of Developmental Disabilities ADA Coordinator at 602-542-0419; TTY/TDD Services: 7-1-1. Empleador/Programa con Igualdad de Oportunidades Bajo los Títulos VI y VII de la Ley de Derechos Civiles del año 1964 (Título VI y VII) y la Ley de Estadounidenses con Incapacidades del año 1990 (Americans with Disabilities Act: ADA), Sección 504 de la Ley de Rehabilitación de 1973, y la Ley de Discriminación a Edad de 1975, el Departamento prohíbe discriminar en los programas, entradas, servicios, actividades o el empleo basado en raza, color de piel, religión, sexo, origen nacional, edad, e incapacidad. El Departamento tiene que hacer arreglos razonables para permitir a una persona con una incapacidad participar en un programa, servicio o actividad. Esto significa, por ejemplo, que si es necesario el Departamento debe proporcionar intérpretes de lenguaje en señas para personas sordas, un establecimiento accesible para sillas de ruedas, o materiales con letras grandes. También significa que el Departamento tomará cualquier otra medida razonable que le permita a usted entender y participar en un programa o una actividad, incluso efectuar cambios razonables en la actividad. Si usted cree que su incapacidad le impedirá entender o participar en un programa o actividad, por favor infórmenos lo antes posible qué necesita para acomodar su incapacidad. Para obtener este documento en otro formato u obtener información adicional sobre esta política comuníquese, con el coordinador de la ADA de la División de Incapacidades del Desarrollo al 602-542-0419; Servicios de TTY/TDD: 7-1-1.